the thoughts of a surgeon in the notorious province of mpumalanga, south africa. comments on the private and state sector. but mostly my personal journey through surgery.

Saturday, August 04, 2007

tears

when i started surgery i had a foolproof plan. when the prof said something that i knew was wrong with everything in me, i would look him in the eyes and in a clear strong voice, without hesitation, i would say, "ja prof (yes prof)". that was until one day.

i did my morning round with the students as usual. nothing to write home about. i went up to the prof's office with the other registrars to hear the night's events as relayed by the guy on call. then the call came. one of my students called me directly to come and help with a resus. it was someone else's patient that had apparently crashed. my students happened to be there and started a resus. they called me. to be homest i wanted to tell them to call the guy whose patient it was, but they were my students, so i ran.

when i got there, it was a mess. they sort of had secured an airway and they were bagging. i tubed quickly and delegated someone to do cardiac massage. we went at it for some time with fair to good effect. at about that stage, the prof turned up. he checked out the situation and decided it was futile. he terminated the resus just like that and we all turned and walked away. the one student that had initially started resussing the patient was visibly shaken. i could see her biting the tears back, those that she could. the rest rolled down her cheeks. i felt for her. i decided to warn the prof that she was a bit tender and needed softer treatment than his usual. what a mistake.

on the ward rounds, the student mannaged to compose herself by the second patient. i was so proud of her. it was then that the prof let his first firey arrow go. he asked her why she had been crying. it was so obvious that i cringed. not only had he been the one to terminate her first resus, thereby dooming it to failure and making her feel some level of responsibility fot the death of a person, but i had told him she was feeling tender so he knew bloody well why she had been crying. the student burst into tears again. the prof made some ill timed comment about living with it and turned around to move to the next patient. i wanted to hold her and tell her it would be ok. my job was to walk next to the prof. so that's what i did. i felt her hurt.

later on in the round, we got to a patient that was to be presented by that same student. she started. she was doing well. then the prof stopped her mid stride. "did you listen to the heart?" "yes prof." "did you look in the ears?" "yes prof." "did you do a fundoscopy?" what the F??? i thought, but held my tongue. "no prof." and then he let her have it. i phased out. i couldn't bare to listen to him rip her to pieces. he went on for about 5 minutes and she held her composure. but he just wouldn't stop. looking back i realise he was not going to stop until he had broken her, but at the time, stupidly, i hoped for mercy for her sake. she broke. she cried for the third time on one ward round. the prof turned and walked.

i turned and walked with the prof, but not before giving the student a quick squeeze of the arm in some sort of attempt to say 'it's ok' but it was far from ok. as i walked with the prof, i felt physically sick. i wanted to say to him that it was cowardly to beat the crap out of an innocent girl. i wanted to tell him my respect for him had died, but i did not. i just walked in silence next to him.

but when i played the event back in my mind later i knew that i could no longer look into the prof's eyes when he was wrong and simply say 'ja prof'. and i no longer did.

I've been interested reading your hints about surgical training. You seem to suggest that training for surgeons should be brutal. Obviously, surgical training should be rigorous, and call trainees to a very high standard. But does it require the sort of "breaking down" of trainees that this post describes? Is it possible to demand an extraordinary amount from someone without taking to their limit and past it?

Or in "breaking them down" do you teach them that they can move past their limit, that in order to be even just a good surgeon, they have to redifine who they are and where their limits are?

Thanks for a difficult, but thought-provoking post. I'm going to continue my musing on this topic on my blog.

i do not think surgical training should be brutal. on the contrary i strongly differ with this view. all i am saying is that on many levels my experience of it was brutal. that does not mean i would want to perpetuate this. i would rather be instrumental in changing it. however, rigorous is necessary, unfortunately for the candidate. not so unfortunately for his future patients.

Well, what a jerk he was, your prof. Sounds like someone who is so miserable that the only way he could feel better about himself is to make someone else more miserable. What else would there be to gain by singling her out? What was the lesson to be learned? Don't show compassion or your emotional state will be exploited? And how frustrating for you to find yourself between professional diligence and common decency. When I tell surgeons there is no way that I could break bad news to family because it would be hard for me not to cry with them, I am told that it is not so much a bad thing. It would be worse, they tell me, to have no emotion.The things one sees in surgery can be brutal, mutilations, abused babies, motorcyclists with faces left on the pavement, but I see no reason to be brutal in our treatment of each other. We are all on the same side.

yes, make. i used to tell the junior guys that in our department, the secret was to show no weakness. such a bad principle, but in that context it actually rang true. this was only one of many stories. they believed in toughening us up. i did not fall for it. i believed in so much more. i love surgery and took it personally when my seniors turned potential surgeons away because they were such assholes.

interestingly enough, the student in question actually considered surgery after her rotation, which i see as a feather in my cap. she did not actually go into surgery, but she did consider it for a moment.

I am glad to hear your opinion of him changed after witnessing his treatment of this student. He was misguided.

I find myself time and time again trying to remind others - not to mistake kindness and sensitivity for weakness.

The ones that are sensitive can have an amazing strength. Their compassion can aid others in healing. Patients that feel cared for, are going to want to please their caregiver. They will try to reach the goals placed before them, because they feel valued.

People such as this student, when they are young, will need to learn how to balance out their sensitivity and compassion, and given the chance they will. They will flourish under the right teacher. They will learn they have to put it aside to do the job at hand. Once they do, they will be a valuable asset. With their heightened senses they will be acute observers and will be thorough in their assessments.

He was out of bounds. I believe he viewed her as weak and thought she would never "cut it". Huge loss, if he succeeded, instead of seeing the potential and handling it differently. I dare say - you learned from witnessing this. I am glad to see you thought differently, as you witnessed this inappropriate handling.

i felt bad for the student who was ripped apart. This, if you notice happens most of the time to girls especially when they are well to do. Is it because gals cry and most of the times guys do not cry and hence the sadist does not get his satisfaction? Is it because these sadists are irritated about their low pay as teachers and when they see well to do they go about ripping them? First time resuscitation failure makes you feel rotten. Feels like you could have done more, may be the patient died because of failure of doing thing more properly… The guilt hangs on for quiet some time. I can imagine the poor girl. Showing your feeling towards this by even a small squeeze shows how good you are – smalltowndoc.wordpress.com

Followers

other

Technorati

blogburst

this blog was the runner up in the literary category of the 2009 and 2010 medical weblog awards

blog awards????

disclaimer

the aim of this blog is to give insight into the mind of a particular surgeon, me. although every story is loosely based on fact, patients have been changed suitably to protect their identity. the opinions expressed are mine alone and are not meant to be considered medical advice or the opinion of any institution.